Social Care

Andy Burnham Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

I will give way shortly, but I want to finish my point about the critical role played by care staff. In total, 1.5 million people work in the social care sector, and I want to mention one group in particular: the 90,000 who come from the EU. They do a brilliant job and we value their contribution to the sector.

If the House will forgive me, I want to share one story from early in my time as Health Secretary about an absolutely brilliant manager, who is Polish, of a dementia care home in Swiss Cottage. The people at the home had advanced dementia and many were unable to talk or move, so the atmosphere in the home was challenging to say the least. I asked the lady how she motivated her staff every day, and she said, “If I can get a resident to smile, they won’t remember it the next day, but I do, and I go home with a smile on my face.” The care that was being provided was, to be frank, completely remarkable. This is a moment for all of us to reaffirm what the Prime Minister said today at Prime Minister’s questions: we want these people to remain and we are confident and optimistic that we will be able to get them to remain.

[Andy Burnham (Leigh) (Lab)]

rose—

[Mr Hunt]

I will give way to the right hon. Gentleman, but I want to give way first to my former ministerial colleague.

[Mr Hunt]

I absolutely want to be someone in this role who confronts poor care and does everything possible to fight for the highest standards. That is exactly why I am doing this job. Poor care comes in different forms and, yes, funding is an issue. As the health and social care system goes through perhaps its most financially challenging period since the founding of the NHS, I particularly want to ensure that we protect the high standards that the right hon. Gentleman cares about.

[Andy Burnham]

I heard the Secretary of State’s earlier words about EU carers. I am sure that they were genuine, but words are not good enough for them. The longer the Government leave them in limbo, the greater the risk is that they will leave. Our national health service and our care system could not cope with losing all those staff, so what more is he doing? Is he petitioning the Prime Minister for a decision now that will give them leave to stay and properly respects their contribution to our society?

[Mr Hunt]

With respect to the right hon. Gentleman, with whom I have enjoyed many debates in this House, neither he nor I wanted the Brexit vote to happen, but now that it has, we have to cope with a very changed world. The Prime Minister said that she is confident of getting an early agreement. I hope that what we are saying in this House this afternoon will resonate with people and make them understand just how valued they are.

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[Andy Burnham (Leigh) (Lab)]

I congratulate my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—my good friend—on an excellent speech. She has no equal in this House as a champion for older people and their carers. Her speech, unlike the speech by the Secretary of State, was firmly rooted in the real world.

This is the century of the ageing society. Caring for people as they live longer lives is the greatest public policy challenge of our times, but for years Parliament has shown itself to be unequal to that challenge. I want to speak today to tell the story of the efforts to reform social care over the last decade, because I want the facts to be on the record, so that people can understand what happened and vow to do better. The story explains the mess we are in today. To be honest, it is quite a shocking story of partisan point-scoring and, worse, political cowardice, which have seriously failed millions of older and disabled people.

The story started nine years ago at the spending review in 2007. I was Chief Secretary to the Treasury at the time, and at the insistence of the Treasury I gave the Department of Health the condition on its spending review settlement that it would conduct a root and branch review of the funding of social care. There was a recognition, even in the Treasury, that if we allowed the situation to continue, it could, in the end, damage the national health service. Quite clearly, the funding was not sustainable, and if social care was left to collapse, it would drag down the NHS with it.

The urgency of such action had been recognised almost a decade earlier, in 1999, when a report by a royal commission on the matter recommended free personal care, paid for by general taxation. It did so for the reason that if we pay for free preventive care in people’s homes, those people do not end up in hospital and costing us all more. Nothing was done, and by 2007 the need for reform was urgent. So between 2007 and 2009, a huge amount of detailed modelling work was done and options were looked at.

When I arrived in the post of Health Secretary in 2009, the work had come to a head. The analysis supported a clear conclusion that radical reform, rather than patching up, was needed. Department of Health officials supported the Treasury analysis that there would be risks to the NHS if social care was allowed to decline. A Green Paper was published in July 2009, and the idea of a national care service was first put forward. The thinking was that only by bringing the systems together, with a system of clear national entitlement, would we be able properly to move towards integration. The maintenance of two entirely differently funded systems—one free at the point of use and the other means-tested and charged for—would mean that they would never be able to speak the same language and there would always be barriers to integration.

I was ready to grasp the nettle, because it was clear to me that the NHS was facing a decade of lower funding from 2010 and 2020, and that one of the ways it could cope with that was with the efficiencies we could unlock through properly and fully integrating health and social care and by moving from a hospital-based medical model to a person-centred social model of care starting in the home.

This is where things went wrong. Picking up that I was ready to up the momentum for reform, the then shadow Health Secretary, Andrew Lansley, approached me in Portcullis House just before Christmas 2009 and asked me for cross-party talks. I thought about it, but I agreed. I thought, as my hon. Friend the Member for Barrow and Furness (John Woodcock) has suggested, that we should take the issue out of party politics, which would be better for everybody. We had a couple of meetings, in which we went round the issues. I favoured the more ambitious, comprehensive reform of paying for social care on the NHS principle—that everybody contributes, but everybody is covered for their care needs and has peace of mind in later life. Andrew Lansley wanted a more voluntary system, in which the insurance market would come up with solutions. That was where we left it.

Then a bombshell was dropped in February 2010: the poster saying, “Now Gordon wants £20,000 when you die.” I very vividly remember the day when it landed. I was told that Andy Coulson had put pressure on Andrew Lansley to do it, and that he did not really want to, but felt he could not say no. I do not know whether that is true, but I know that the Conservatives, who asked me for cross-party talks, betrayed the confidence that I gave, and they have never seen fit to apologise for that. The point is not about the personal political damage that that did, but about the chilling effect the poster had on the social care debate. It instantly killed any talk of radical reform, and it actually had a deadening effect for the rest of the following Parliament—the last Parliament—during which no real progress was made.

That brings me to what happened after the election, when, as shadow Health Secretary, I challenged the Government from the Opposition Front Bench about the poster that they had put out during the election saying that they would cut the deficit, not the NHS. I made the point that if they did so, they would in effect cut social care: if they prioritised NHS spending within the reduced envelope, that would have devastating consequences for social care and would in the end come back to affect the NHS.

From the Dispatch Box at every Prime Minister’s Question Time, the then Prime Minister used to quote me as claiming that it would be irresponsible to give the NHS real-terms increases, but he never commented on the second part of what I had said, which was that it was irresponsible to do so if we were cutting social care. I did say that, and it was irresponsible to social care in the way they did to pay for their commitment to the NHS. Social care was cut by 9% during the last Parliament, with 400,000 vulnerable people losing support in their homes. Those people ended up in A&E or trapped in hospital beds, piling pressure on the hospital system.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I pay tribute to the right hon. Gentleman—this may be my last chance to do so—for the work he has done as a Member and wish him well in his future career if he is successful in his election. Does he agree that the chilling effect of the outcome of those conversations before the election and perhaps the betrayal of his confidence, as he puts it, is that there could no longer be a rational conversation about properly funding the health and care system through any form of taxation? That is the problem that has emerged, and perhaps the best way to fix it is through general taxation.

[Andy Burnham]

I am very grateful to the hon. Gentleman for his intervention and the spirit in which he made it. He is absolutely right: that set everything back and meant that there was no possibility of a cross-party approach. There will have to be such an approach if we are to fix social care and, indeed, to give the NHS what it needs, because they will both need more funding during this Parliament. That is the real shame. I did not make my point about Andrew Lansley for political reasons; I just want people to understand what happened, so that the current generations of politicians might do something different.

The answers we have since had from the Government are wholly inadequate. We have heard today that the precept does not raise enough money, particularly for poorer councils. It is no answer; in fact, it just cynically devolves the responsibility for the whole issue to local government, even though councils did not create the problem. I still favour an all-in system. I will say it: I favour a system in which we ask older people to pay a set contribution, so that they have peace of mind in later life, with all their care costs covered.

[Mr Jeremy Hunt]

I am listening very carefully to the right hon. Gentleman. In the spirit of wanting to rise above party politics, will he agree that it was totally wrong of him to suggest at any stage in the last Parliament that the Government wanted to privatise the NHS, when we have never had the intention to do so? It was wholly irresponsible to scare the public about that.

[Andy Burnham]

In a week when Virgin Care is taking on a huge community care contract, I do not think the Secretary of State should be making that point—particularly the Secretary of State who privatised ambulance services in Greater Manchester. I honestly do not think we need to go there.

The point that I am making is about funding social care. The Conservatives claimed that we were introducing a new inheritance tax. Do people not understand that just 3.4% of estates in this country attract inheritance tax? Why is that? Because the vast majority of estates are whittled down by the costs of care—tens of thousands of pounds, or hundreds of thousands of pounds for some people. That is not fair and it is not sustainable. We must be able to do better.

I feel so strongly about this because I saw my grandmother go through the care system in England 20 years ago and, frankly, it was nowhere near good enough. I arrived here saying that I would do something about it. I tried to do something about it, but we have not got anywhere near a solution to the scale of the challenge. People will need to put party politics aside and find common ground. The point scoring and failure to grasp big issues have led to a situation where people have low regard for this place.

We are left with a malnourished, privatised care system in England that is sinking lower as we speak. A culture of slap-dash 15-minute visits is entrenched, in which staff do not get properly treated, trained or respected. Standards in care homes have slipped even further, and stories of neglect and abuse abound—we hear them all the time. Countless vulnerable people and their families still have to pay these cruel dementia taxes, which have risen under this Government, losing everything they have worked for and going into later life with everything on the roulette table: home, pension, savings—the lot. That is not the care system we should have in 2016 in this country. At what point are we going to say, “Enough is enough,” and actually do something about it?

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[The Parliamentary Under-Secretary of State for Health (David Mowat)]

We have had a good debate, with a number of very good speeches from both sides of the House. I will try to respond to the points, or the themes of those points, that have been made.

First, I want to address the accusations, made by Labour Members, of criminal behaviour in relation to the minimum wage not being adhered to. If such evidence exists—I think the hon. Members for Sheffield Central (Paul Blomfield) and for Tooting (Dr Allin-Khan) raised this issue—please bring it to me. I will see that it goes to Her Majesty’s Revenue and Customs. Those involved will be named and shamed. Such behaviour is illegal and is not to be tolerated. I think the hon. Member for Tooting also said she had evidence that a care home or domiciliary supplier was forging attendance sheets. Again, if there is evidence of that I would like it to be brought forward. It should not just be bandied about here in a political way. We should investigate it and we will. If she brings that evidence to me, we will look at it.

One of the big themes in this debate, and one with which Members on both sides of the House can agree, is the importance of carers. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about that and, rightly, about the need for a better career structure and clearer training requirements, a point the Cavendish report also addressed. Some 1.5 million people work in domiciliary and care homes, but—this is a very difficult statistic—the annual turnover is about 25%. That is caused not just by poor pay—I am proud to be part of a Government who have increased the pay of many of these people—but by a lack of career structure and, frankly, of regard, and we need to do more on that. She was right to raise it.

My right hon. Friend the Member for North East Bedfordshire (Alistair Burt) made the important point that, as well as the 1.5 million paid carers, there are 1.1 million unpaid carers. In many ways, these are the unsung heroes of the entire system, and we can all agree we need to do better by them. When he was doing my job, he kicked off the carers’ strategy, which we will be coming forward with. It is a cross-Government initiative and will result in concrete actions to make the 1.1 million-strong unpaid carer cohort better off.

Several people talked about finances and money. Of course they are tight. The Secretary of State made it clear that in the last Parliament, in order to respond to the situation we inherited, there were cuts to local government funding. During the course of this Parliament, there will be a real increase in the rate of adult care funding, but that is not to say we do not understand that the system is under pressure. We understand that, as Simon Stevens said, if more money was available, it would be good if it went into the social care system.

Members on both sides of the House spoke about bed-blocking caused by a lack of money, and about delayed transfers of care, and it is true. Of course there is a correlation between the amount of money in the system and the number of delayed transfers of care, but one of the most extraordinary things about the numbers is that, between the best and worst 10% of local authorities, in terms of the number of DTOCs, the difference is a factor of 20 to 25. That is not just about budgets—budgets are not 20 to 25 times different—it is about leadership; about good people doing good work; about spreading best practice; about shared assessments, early discharge and discharge to assess; and about integration in the widest sense, as my right hon. Friend the Member for North East Bedfordshire said. Those councils, local authorities and health systems that have gone fastest and furthest with integration—the holy grail that the right hon. Member for Leigh (Andy Burnham) talked about—are those at the top end of the DTOC statistics. We should all think about that when we say, “We want more money.” We should all think about the reasons for that difference.

I would make another point about finance. An Opposition Member talked about the GDP equation getting worse in this Parliament. That is not true, but I would just make this point: in 2016, the OECD looked at the money spent on adult social care right across the major economies of Europe, and we in the UK spend about 20% to 25% more than other major industrialised countries such as Germany and France. That is not to say that the system is not under pressure in our country—it clearly is—but the facts are that other countries do a better job in terms of long-term saving, social insurance and some of those types of things. We clearly have an issue with this. Let me repeat that Germany and France, which in the round spend more on the entire health system than we do—about 1% more as a proportion of GDP—spend 25% to 30% less on adult social care. It is critical to spend what we can spend better.

[Andy Burnham]

I hear what the Minister says, but it seems to me that, in common with the Secretary of State, he is avoiding the main issue. The main issue is the urgent financial crisis that councils are facing. They have not got enough money to care for the people who need care. Will the Minister answer a direct question? Has he or the Secretary of State made a submission to the Treasury for more funding for social care as part of the autumn statement—yes or no?

[David Mowat]

We are not having the autumn statement today, and we are not going to give a commentary on what will come out of the autumn statement. We—the Secretary of State and I—have accepted that the care system is under pressure. I was just making the point that other countries spend less, and that we need to spend every penny we can as effectively and as well as we can. During the course of this Parliament, moreover, there will be a real increase in the amount of spending on social care.